| National Provider Identifier [NPI]: | 1356621478 |
| Last Name Of The Provider | ROSE |
| First Name Of The Provider | CRYSTAL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 71 HAYNES ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MANCHESTER |
| Zip Code Of The Provider | 060404131 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 458 |
| Number Of Medicare Beneficiaries | 407 |
| Total Submitted Charge Amount | 453475.55 |
| Total Medicare Allowed Amount | 50817.05 |
| Total Medicare Payment Amount | 37370.79 |
| Total Medicare Standardized Payment Amount | 42081.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 458 |
| Number Of Medicare Beneficiaries With Medical Services | 407 |
| Total Medical Submitted Charge Amount | 453475.55 |
| Total Medical Medicare Allowed Amount | 50817.05 |
| Total Medical Medicare Payment Amount | 37370.79 |
| Total Medical Medicare Standardized Payment Amount | 42081.41 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 131 |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | 92 |
| Number Of Beneficiaries Age Greater 84 | 101 |
| Number Of Female Beneficiaries | 254 |
| Number Of Male Beneficiaries | 153 |
| Number Of Non Hispanic White Beneficiaries | 344 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 203 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 204 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 19 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6729 |